title: Quality of life after ischemic stroke varies in western countries: data from the tinzaparin in Acute Ischaemic Stroke Trial (TAIST).
abstract: Functional outcome after stroke varies significantly between countries. However, whether health-related quality of life (QoL) after stroke also differs between countries is unknown. TAIST was a randomised controlled trial assessing the safety and efficacy of tinzaparin versus aspirin in 1484 patients with acute ischaemic stroke across 11 countries. Countries were grouped into 5 geographic regions: British Isles (Ireland and UK), Franco (Belgium and France), North America (Canada), northwest Europe (Germany and The Netherlands), and Scandinavia (Denmark, Finland, Norway, and Sweden). QoL was measured at 6 months using the Short-Form 36 (SF-36) health survey. The relationship between region and QoL was assessed relative to the British Isles using linear regression adjusted for case mix, service quality variables, and treatment assignment. A total of 1220 survivors were included in this analysis. Significant differences in QoL were identified between countries and regions; northwest Europe rated their QoL highest in terms of physical functioning (20.3; 95% confidence interval [CI] 10.8-29.8), bodily pain (12.3; 95% CI, 2.7-22.0), and vitality (9.0; 95% CI, 1.1-16.9). Franco countries reported the lowest QoL for emotional role (-17.9; 95% CI, -32.6 to -3.3) and mental health (-11.2; 95% CI, -18.2 to -4.3). The British Isles rated QoL lowest for physical and social functioning. Our data indicate that QoL varies considerably among countries and regions, even when adjusted for prognostic case mix and care quality variables. How different case mixes and healthcare systems might contribute to these findings merits further investigation.
authors.affiliation: Institute of Neuroscience, University of Nottingham, Nottingham, UK. nikola.sprigg@nottingham.ac.uk
authors.forename: Nikola
authors.initials: N
authors.lastname: Sprigg
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Gray
authors.forename: Philip M W
authors.initials: PM
authors.lastname: Bath
authors.forename: Hanne
authors.initials: H
authors.lastname: Christensen
authors.forename: Peter Paul
authors.initials: PP
authors.lastname: De Deyn
authors.forename: Didier
authors.initials: D
authors.lastname: Leys
authors.forename: Desmond
authors.initials: D
authors.lastname: O'Neill
authors.forename: E Bernd
authors.initials: EB
authors.lastname: Ringelstein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000627:therapeutic use*; D002545:Brain Ischemia / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D016009:Chi-Square Distribution; D004644:Emotions; D005060:Europe; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D054625:Healthcare Disparities; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D016014:Linear Models; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009656:North America; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D012111:Residence Characteristics; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D011795:Surveys and Questionnaires; D013997:Time Factors; D000078222:Tinzaparin; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D000078222:Tinzaparin; D001241:Aspirin